Acute hospital at home – an integrated, holistic and multidisciplinary service

Results

AH@H is a virtual inpatient ward run by a multidisciplinary team, who provide aspects of inpatient care to people in their own homes. Services provided include:

• intravenous antibiotics (including administration via Surefuser pump)

• facility to insert and manage PICC/mid-lines.

• consultant-led daily virtual ward round

• twice weekly review by senior house officer doctor at home

• nursing assessments and observations (recorded electronically at the patient’s home, through VitalPac)

• complex wound care, including VAC pump dressings

• blood tests

• physiotherapy, occupational therapy, speech and language therapy and dietitian input

• coordination with ambulatory care to arrange specialist reviews, further tests or imaging.

Since 2016 a D2A service has been developed that bridges care packages while giving multidisciplinary therapy input.

The AH@H service treats patients with a variety of medical and surgical conditions, the most common are:

• respiratory infections- exacerbations of bronchiectasis/COPD/asthma and pneumonia (17%)

• cellulitis (14%)

• venous thromboembolism (5%)

• septic arthritis (4%)

• infected diabetic foot ulcers (4%).

Between January 2014 and September 2017, 1,433 patients have been managed through the AH@H service, saving on average 9.64 bed days per day, with a re-admission rate of only 4.75%. A key success is the high degree of patient satisfaction: 98.13% of patients were ‘likely or extremely likely to recommend the service’ in the Friends and Family Test, compared with 83% on an inpatient ward. Patients feel they recover much better in their own home, eating their normal diet and being able to rest in a more relaxing environment without the disturbances of a busy inpatient ward. The average cost per day of an AH@H is £100, compared with £280 for an inpatient ward bed.

Between April 2016 and September 2017, D2A has managed 379 patients, saving on average 5.58 hospital bed days per day, while reducing 28.5% of patient’s care needs and 21.11% regaining independence, no longer requiring a package of care.